The medical supervision of athletes including cyclists, in the broadest sense of the word, has gradually developed into a medical scientific machine in many fields such as training (power measurement), food, materials (aerodynamics), pharmacology (pharmacological interference with or without doping), psychological counseling and much more.
In international cycling four periods can be distinguished:
1870 – 1960: acceptance of performance enhancing drugs.
1960 – 1990: attendance anti-doping policy and shift doping use.
1990 – 2008: the impact of EPO and tightening anti-doping policy.
2008 – 2016: reduction in acceptance of doping and intensification of the fight.
2016: first case of mechanical doping.
1870 – 1960
Doping was used from the beginning of cycling in 1870 doping. The main reason was the fact that from the beginning cycling was a professional sport. But also because the cycling races were incredibly long and heavy. Like Paris-Brest-Paris, a non-stop race across more than 1,200 kilometers. And the very popular six-day races where riders were almost constantly on the bike. The popular sport of cycling gave the workmen distraction from their hard existence. At that time it was very common that miners worked more than 16 hours, and stimulants were administered in order to perform better. It is understandable that at that time it was for people the most natural thing in the world that cyclists also used stimulants. Doping in cycling has a clear historical background.
During the period after World War II, the riders made frequent use of amphetamines (such as Benzedrine) which soldiers and military pilots used during the war to combat fatigue and to suppress their anxiety. The use of such performance-enhancing drugs has long been a fully accepted part of cycling. There was no policy to control the use.
1960 – 1990
Only since the end of the fifties, there arose some discussion. Doping would be contested. The death of Danish cyclist Jensen fuelled this debate.
During the 1960 Olympic Games in Rome Italy, the Danish cyclist Knud Jensen died, in the road race, as a result of the use of amphetamines. Jensen was an amateur who used amphetamine after advice from professional riders. From his training group in Denmark.
In the early sixties, the first measures against doping were taken, especially because of the use of doping by professional cyclists. But at that time there was still considerable uncertainty about the harmfulness of doping to health. That was in 1964, the conclusion of an international conference held in Belgium: the “International Seminar on Doping” attended by many eminent scholars came with the following conclusion:
….. “there is no evidence to support the proposition that small amounts of stimulants such as amphetamines, 14 mg per 70 kg body weight as used by Beecher, have toxic effects in combination with heavy sport effort.”
The role of doctors in the medical supervision of riders became more and more important. That meant the fight against doping, conducting sports medical examinations, treatment of injuries, the making of training schedules and nutrition instructions and testing for physical fitness and condition was done by doctors. More and more doctors became also involved in professional cycling. There they were confronted with the widespread use of doping and with soigneurs who were involved in its administration. According to Jacques Anquetil, five-time Tour de France winner, each cyclist used drugs for enhancing the performance and those who claimed they were not doing it to be regarded as liars. Dutch doctors as J. Rolink A. Rozijn, P. van Dijk who got involved in cycling, saw the use of doping in the first place as a matter of cowboy operators. Not the soigneurs but the doctors themselves would have to administer the drug. Van Dijk wrote in 1960:
“The task of us, doctors, in the coming years must be: to get the administration the administration of stimulants out of the hands of the soigneurs and other unauthorized persons.”
The death of Tom Simpson, who died on the slopes of the Mont Ventoux on July 13, 1967 due to a combination of warm weather, a heavy exertion, alcohol and doping, ensured that doping came increasingly attracted the attention of policymakers.
From 1965, the UCI introduced the first doping controls.
The cycling world and the general public saw doping still not as a big problem. Although several riders, including Eddy Merckx, Luis Ocaña, Didi Thurau and Joop Zoetemelk were caught using stimulants, but public opinion responded not too fiercely on it. It was seen as a offense of the rules that had to be punished, but not as a problem that affected the fundamentals of the sport. The punishments were by today’s standards still very mild. This ranged from a time penalty of 10 minutes and a penalty to be placed in the last place in the general classification or be completely deleted from the results.
Exogenous testosterone could already be detected at that time by determining the T / E ratio in the urine. That is the ratio between testosterone and epitestosterone. If no testosterone was injected or swallowed this ratio is 1. After an injection of testosterone or an oral dose of, for example a scoop of andriol this value could be higher than six, which meant a positive doping test. We discovered that a scoop of andriol taken immediately after the race at 17:00 in the afternoon, the next morning still gave a T / E value of about 50, but that the T / E value in the afternoon, at 5 o’clock, so after the race, was normalized to 1 or 2. The result is easy to guess. Especially during stage races andriol was widely used to recover better and faster. After each heavy stage it became routine because they believed that it worked for a better recovery and make them fresh and strong for the next day’s race.
It was also the period that deca durabolin could be detected for the first time. The trouble was that the detection method worked so well that decaduraboline caused a positive urine test for several months. One of the riders who had been well prepared with decaduraboline during the winter turned out to have a positive test in August for the drug. He rode his races anonymously to avoid a doping test, but was still chosen at random* for doping control. As was expected, so after a bladder wash he could confidently undergo the control.
* Each rider has a number. If his number is drawn he has to go to the doping control. But riders who perform remarkably well simply be designated for doping control.
Already in this period cortisone was injected and swallowed on a large scale.
It was the drug for the classic races in the spring. Some riders respond well to this drug and rode exceptionally strong, but others blocked completely and could only follow the peloton with difficulty. The use could not be stopped at all. Cortisone, after all, could not be detected. The only thing I could reach was to get the use of this drug under control, so be sure not too often, in order to prevent the own cortisol production of the rider would fully stop. I experienced a few times riders with too low cortisol levels, and even zero. At the very beginning in 1987 but also in 2009, my last year with Vacansoleil. Kenacort A 40 and Diprophos were the main drugs which were used.
It was also the time and the beginning of blood transfusions with own blood because private blood banks arose where businessmen could freeze a few bags of their blood. That blood was to be used for them if anything happened during their business trips in Africa. If they needed a blood transfusion or save blood from the Netherlands could be flown in quickly by plane because blood from a local African blood bank was too risky for infection with AIDS.
But abruptly the use of blood transfusions ended because of the introduction of a new spectacular medicine that was much more easy to use than the laborious blood transfusions. This drug would completely change cycling and its effects are to be found up to the present day. The drug showed the complete failure of the UCI and in particular their chairman Hein Verbruggen. Doping authorities functioned beneath contempt and were unable to detect the agent. The victims were the riders who had no choice. If a rider wanted to continue to practice their profession then the use of EPO was a must.
EPO or ERYTHROPOIETINE
Doping is a wrong word when it comes to EPO, a high quality drug; in the case of doping I think of products harmful to health.
The use of EPO in sport and not only in cycling was very large. In January 1997 UCI conducted blood tests in which the haematocrit was checked. A rider with a haematocrit above 50 got a ban to race for 14 days. That was not a doping penalty but a health measure. A rider with a haematocrit above 50 would have a risk for health problems. This view could not scientifically be fulfilled but in fact the measure was not intended to protect the riders but it was intended to limit the excessive use of EPO. After this measure the whole peloton started using EPO up to the limit of 50 but this limit was not exceeded. In 2000 just before the Sydney Olympics a combined blood – and urine test was introduced to detect EPO. The test was getting better and better and for that reason blood transfusions came again in the spotlight. Major scandals that were discussed were the Festina Affair, the TVM affair, the drama Marco Pantani, the exclusion of Erik Dekker after the World Cup in 1999 in Verona and the Muppet show of Professor Jo Marx Dekker who gave him an excuse by which he was not punished. The donation of a lot of money from Lance Armstrong to the UCI (read Hein Verbruggen). The maffia-style dual role of the UCI which protected riders incorrectly and thereby were maintaining the problem of doping.
Occasionally amphetamine was still used, by the staff as they had to do extremely long journeys without a decent rest. I provided them with amphetamines and for that reason I had to give my explanation to the Inspector of Health, Plokker was his name if I remember correctly. He accepted my explanation. His only advice was to write a regular prescription for amphetamines.
Some riders used amphetamines to train long and hard, especially in the winter and the preseason, to bear the cold and the rain.
It was customary for all teams and riders to administer after the race recovery products. Usually it went by infusion or intravenous injection. The list of authorized resources that was used for that is infinitely long. In each country where races took place, there were several pharmacies who specialized in medication for cycling. The addresses of the pharmacies were exchanged with fellow team doctors. The ‘no needle policy’ of the UCI now forbids administering injections for riders. A rule which is intended to eliminate the use of recovery products. Each injection must now be notified in advance. Offense equals a positive doping test. A rider who receives an injection without authorization is currently provided automatically gets a start prohibition of eight days. Incomprehensible that the cycling doctors did not organize massive resistance to this idiotic ban.
MEDICINE POTS FOR DURING THE COURSE
During the race the riders use small medicine pots, containing a variety of tablets to digest the effort better. One pot for the beginning of the race, the final pot was only used if the rider still faced a good result.
THE YEAR 2016
The first case of mechanical doping. The Belgian cyclo-crosser Femke Van den Driessche is caught for mechanical doping during the World Championship. Within her bike a well concealed little motor was detected by the UCI officials. Six years after the first conspicuous victories of Fabian Cancellara in the Tour of Flanders and in Paris-Roubaix the proof of mechanical doping is finally given.
The scandals of doping and corruption in sports just increase. In seriousness and size of the cheating methods The International Athletics Federation (IAAF) has overtaken the UCI, the Union Cycliste Internationale. The 82 year old Lamine Diack has been the leader of athletics for 16 years and only after the end of his chairmanship it came out to what extent this Senegalese was corrupted. He had stolen millions of Euros amongst other things by blackmailing doping-positive athletes.
Hein Verbruggen resigned as the chairman of the cyclists Union UCI in 2005. He could not be proven corrupt. Although he received large sums of money from Lance Armstrong, who got a special treatment in return. For that matter, Armstrong was never tested positive during his career. He and many other riders were protected by Verbruggen and his UCI and especially informed when doping tests were planned. Positive urine sampled were suspicious indeed, but the UCI did not dare to punish the riders because they did not want to run the risk of losing a lawsuit and be convicted for paying large sums of compensation.
Russia and all Russian athletes were recently banned from international sports events after a decisive WADA report. Also the Russian Athletics Union and the Russion Antidoping Institution were corrupt to the core.
The World Football Federation FIFA and their European branch UEFA under the leadership of Sepp Blatter and Michael Platini and after them an endless train of corrupt fellow-leaders have cheated the World for years. Also Worawi Makudi, chairman of the Thai Soccer Federation was suspended because he offered his vote for sale in exchange for the broadcasting rights of a match.
And recently the ever so correct tennis players were found to have sold their matches on a large scale. And now again with officials knowing it. I therefore predict that this mess will never stop.